Digital Commons Network^™

Depression And Poverty Ii. Strategies For Intervention, Donald C. Ohuoha, M.D., M.P.H.

Jefferson Journal of Psychiatry

In Part I of this paper, I reviewed the recent findings in psychosocial causes of depression among the poor, and questions raised by them. In this paper, I will suggest certain strategies for intervention for treatment of this population.

Depression And Poverty I. Psychosocial And Cultural Determinants, Donald C. Ohuoha, M.D., M.P.H.

Jefferson Journal of Psychiatry

The WorldHealth Organization estimates that over 100 million people worldwide suffer from depression, that three times as many may be affected (1). While major advances have occurred in our understanding of the biological aspects of depression, the understanding of psychosocial causes of depression is still largely sketchy. Thus adequate intervention in dealing with this aspect of treatment of depression is scarce. This paper, divided into two parts, will review recent findings in psychosocial causes of depression and suggest certain strategies.for intervention, speculate on the roles of poverty and the issues raised by poverty on the rates of depression and suggest …

Multiple Personality And Channeling, Rayna L. Rogers, D.O.

Jefferson Journal of Psychiatry

Psychiatry in the 1980's and 1990's has seen a rapid progression in the understanding of dissociative disorders, especially multiple personality disorder. Another phenomenon which has had a parallel rise in the past decade is trance channeling. Channeling is the process by which an individual enters a trance-like state and surrenders control of the body to a "guide" or "entity" who communicates with the listeners or "sitters" gathered for a "reading." The purpose of this paper is to investigate the relationship between these two phenomena, specifically questioning whether channeling is a variant of multiple personality disorder or if it is pathological.

Psychodynamic Psychiatry In Clinical Practice, Edward Kim, M.D.

Jefferson Journal of Psychiatry

Glen O. Gabbard, M.D.

American Psychiatric Press, 1990

480 pages $49.95

Dr. Freud Vs. Dr. Spock, Timothy C. Smith, M.D.

Jefferson Journal of Psychiatry

CHILDREN OF PSYCHIATRISTS AND OTHER PSYCHOTHERAPISTS

Thomas Maeder

Harper and Row publishers, New York 1989, 259 pages, $19.95.

Alzheimer's Disease And Down's Syndrome: An Overview, Dr.Devanshu Desai, M.B.B.S.

Jefferson Journal of Psychiatry

The association between Alzheimer's Disease and Down's Syndrome is well recognized through clinical observations and genetic studies. However, the exact nature and the implications of this link is far from clear as yet. The challenge of diagnosis, genetics and the differences in clinical presentations of Alzheimer's Disease in relation to the Down's Syndrome are reviewed here. Promising areas of research are pointed out and importance of relevant family history is emphasized. A current knowledge in the subject through various studies is presented.

The Real Mother-Issues In Adoption, Penelope J. Hooks, M.D.

Jefferson Journal of Psychiatry

Our society has deemed adoption a desirable alternative method of creating a family. It satisifies the need of a child for parents, it gratifies the desire of adults who yearn to provide a home and love for a child, and it gracefully solves the dilemma for the one who cannot or will not raise the child. In addition to the usual developmental conflicts, families involved in adoption will encounter a variety of fears, fantasies, resentments, and misconceptions which may adversely affect identity formation in the child. Here I will attempt to explore some of the psychodynamic issues which will be …

Cognitive Information Processing In Borderline Personality Disorder: A Neuropsychiatric Hypothesis, J.Wesley Burgess, Ph.D., M.D.

Jefferson Journal of Psychiatry

Neurocognitive information processing was compared in 18 borderline subjects and 14 controls of similar age and gender. An 11-item screening examination significantly differentiated the two groups (P < 0.001). Significant differences were found on Delayed Memory, Serial Sevens, Rhythm Reproduction, and Perseveration subtests (P < 0.05). The results are interpreted as evidence for mild frontotemporal brain deficits. The findings support a developmental model of borderline disorder where early stress/injury during the childhood period of frontotemporal vulnerability results in failure to negotiate developmental landmarks and adult deficits in cognition, emotion/behavior modulation, and insight.

Therapeutic Alliance And Involuntary Commitment Of A Minor, Karen Dineen Wagner, M.D., Ph.D, Sharon R. Weinstein, M.D., Richard F. Wagner, Jr., M.D.

Jefferson Journal of Psychiatry

Children are legally entitled to be present throughout the commitment hearing for continued hospitalization. The effect of this process on the therapeutic alliance between the child and the psychiatrist warrants examination. A case study of a 14 year-old boy who participated in the court proceedings is presented. The outcome of the hearing resulted in a disruption of the therapeutic alliance. Alter natives to current commitment procedures for minors are discussed.

Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren

School of Nursing & Midwifery

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …

An Automated Internet Application To Help Patients With Bipolar Disorder Track Social Rhythm Stabilization., Daniel Z Lieberman, Susan Swayze, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

This column describes a pilot study of a fully automated, Internet-based program that provides a key element of interpersonal and social rhythm therapy, a form of psychotherapy shown to be effective in the treatment of bipolar disorder when combined with mood-stabilizing medication. Participants (N=64) recorded the time they completed activities of daily living and their mood at the time of each entry. After 90 days they demonstrated a 31% increase in social rhythm stability and a small, though statistically significant, decrease in symptoms of abnormal mood. Internet-based programs can enhance access to a best practice in the management of bipolar …

Medical Education Digest, Vol. 13 No. 6 (November/December 2011), Nova Southeastern University

Medical Education Digest

No abstract provided.

Patient-Provider Communication Data: Linking Process And Outcomes In Oncology Care, Lisa Kennedy Sheldon, Fangxin Hong, Donna L. Berry

Nursing Faculty Publication Series

Overview: Patient–provider communication is vital to quality patient care in oncology settings and impacts health outcomes. Newer communication datasets contain patient symptom reports, real-time audiofiles of visits, coded communication data, and visit outcomes. The purpose of this paper is to: (1) review the complex communication processes during patient–provider interaction during oncology care; (2) describe methods of gathering and coding communication data; (3) suggest logical approaches to analyses; and (4) describe one new dataset that allows linking of patient symptoms and communication processes with visit outcomes. Challenges: Patient–provider communication research is complex due to numerous issues, including human subjects’ concerns, methods …

Factors Related To Psychiatric Readmissions In A Large Community Academic Hospital, William Stern, Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.

Parent-Led Activity And Nutrition (Plan) For Healthy Living: Design And Methods, William T. Dalton, Karen E. Schetzina, Nicole Holt, Hazel Fulton-Robinson, Ai-Leng Ho, Fred Tudiver, Mathew T. Mcbee, Tiejian Wu

ETSU Faculty Works

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5–11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program …

The Association Between Parity, Infant Gender, Higher Level Of Paternal Education And Preterm Birth In Pakistan: A Cohort Study, Kiran Shaikh, Shahirose Sadrudin Premji, Marianne S. Rose, Ambreen Kazi, Shaneela Khowaja, Suzanne Tough

School of Nursing & Midwifery

Background:

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth, however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth.

Methods:

In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression …

Small Intestinal Bacterial Overgrowth And Lactose Intolerance Contribute To Irritable Bowel Syndrome Symptomatology In Pakistan, Javed Yakoob, Zaigham Abbas, Rustam Khan, Saeed Hamid, Safia Awan, Wasim Jafri

Department of Medicine

Background /Aim: The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth (SIBO). The aim of this study was to determine the frequency of SIBO and lactose intolerance (LI) occurrence in Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) according to Rome III criteria.

PatientS and Methods: In this retrospective case-control study, Patients over 18 years of age with altered bowel habit, bloating, and Patients who had lactose Hydrogen breath test (H 2 BT) done were included. The "cases" were defined as Patients who fulfill Rome III criteria for IBS-D, while "controls" were those having chronic nonspecific diarrhea …

Psychiatrists' Knowledge And Attitudes About The Acquired Immune Deficiency Syndrome, Carol L. Alter, M.D., Ellen S. Dickinson, M.D., Greg Miller, M.D.

Jefferson Journal of Psychiatry

Since 1981 the Acquired Immune Deficiency Syndrome (AIDS) has become the primary health care issue in this nation. Psychiatrists have had a central role in caring for AIDS patients: they have been asked to evaluate and treat patients with neuropsychiatric manifestations of AIDS and emotional reactions to the illness itself, as well as to treat those who are fearful of acquiring AIDS. Numerous studies in the literature have explored the physician and lay population's knowledge and attitudes about AIDS. To date no study has addressed these issues in psychiatrists in specific (1- 9).

Most studies suggest that individuals who have …

The Homicide Witness And Victimization; Ptsd In Civilian Populations: A Literature Review, Gerald M. Streets, M.D.

Jefferson Journal of Psychiatry

People who witness the murder of an individual, whether a family member or acquaintance, often experience their loss as a psychic trauma. This described trauma is revealed by the symptom complex defined in the DSM-III-R as post -traumatic stress disorder (PTSD). Children, in particular, frequently suffer from debilitating grief, which hinders their emotional and cognitive development. This grief may masquerade as a learning disability, hyperactivity, or an attention deficit disorder. Witnessing murder and being victimized (i.e, rape, incest, and physical abuse) are equivalent experiences in their potential for generating massive intrapsychic conflict. Being poor is a predisposing factor which puts …

Exploring Frontal Lobe Dysfunction In Schizophrenia With Positron Emission Tomography, Donald P. Hall, Jr., M.D.

Jefferson Journal of Psychiatry

Frontal lobe dysfunction in schizophrenic pa tients has been highly suspected for many years. Many psychiatrists and patients, however, are awaiting solid proof of a biological manifestation of this disease. While positron emission tomography does not uniformly demonstrate such a manifestation, it does demonstrate a prefrontal cortex deficit in most reported studies. Further, a localization of the attention deficit of schizophrenia, in the prefrontal cortex, is strongly suggested by some studies.

INTRODUCTION

Positron emission tomography (PET) has enabled investigators in modern clinical psychiatry to demonstrate that schizophrenia is, at least in part, a frontal lobe disorder. PET studies of many …

A Case Of Conversion Catatonia Misdiagnosed For 24 Years, Pauline K. Wiener, M.D.

Jefferson Journal of Psychiatry

Catatonia is a syndrome whose etiology may be both diverse and difficult to substantiate. Ms. H. is a 45-year-old black female with 18 previous psychiatric hospitalizations beginning at age 21. A common characteristic to all hospitalizations was a catatonic presentation (i.e ., the patient was mute with marked muscular rigidity; she would refuse to eat or follow orders). In each of her previous 18 hospitalizations, the patient was thought to be psychotic.

It was found that each catatonic episode could be related to a severe psychological stressor. The patient's illness never involved delusions, hallucinations or disturbances in thought form. Upon …

Postpartum Depression In A Caretaking Grandmother: Case Report, Valerie D. Raskin, M.D.

Jefferson Journal of Psychiatry

Postpartum depression has only recently been understood to affect individuals other than the biological mother (1). In such cases, postpartum depression has been attributed to the enormous psychological and social stress of the caretaking role, with its demands to nurture in the face of what may be the sense of having been insufficiently nurtured oneself (2). A growing number of grandparents, especially maternal grandmothers, are being asked to serve as primary caretakers for their grandchildren, due to circumstances which include adolescent childbearing, single parent families and substance abuse. A case report of a new grandmother with significant caretaking functions who …

Book Reviews: Clinical Experiences, Indoctrination And Education In Alcoholism, Marguerite M. Blythe, M.D.

Jefferson Journal of Psychiatry

HEAVY DRINKING: THE MYTH OF ALCOHOLISM AS A DISEASE

Herbert Fingarette

Berkeley, University of California Press 1988, 166 pages

In Response: The Place Of Psychotherapy Training In Residency Programs, Homer C. Curtis, M.D.

Jefferson Journal of Psychiatry

As a belated response to the debate about the value of teaching psychotherapy in psychiatric residency training, (Jefferson Journal of Psychiatry, Vol. 5(I):54-66, 1987) I would like to add my voice to the affirmative side. That there is such a debate seems symptomatic of an unfortunate and unnecessary misuse of important advances in neurobiology to justify the sidelining of psychodynamic psychotherapy. A search of the psychiatric literature of recent years reveals an emphasis on biological psychiatry and a relative neglect of psychotherapy. A similar trend has been noted in some residency programs and in the annual meetings of the American …

Confrontations With Death: Psychological Responses During Internship, Michael Miller, M.D.

Jefferson Journal of Psychiatry

During internship, the daily confrontation with the consequences of disease contributes much to the distress which young physicians experience (I). Not only are interns responsible for first line medical care, they must also provide emotional support for their patients struggling with pain, disability and impending death. This paper seeks to examine some of the factors responsible for the turmoil involved in caring for these dying patients.

Our conceptions of death and dying are determined to a large extent by the cultural context in which we live. Compared with other times in which death was not so ego alien, we presently …

Identity Formation And Reformation In First And Second Career Psychiatric Residents, Steven J. Kingsbury, M.D., Ph.D.

Jefferson Journal of Psychiatry

Although all residents seek to acquire competence, those entering psychiatry as a first career appear to use different strategies for the early protection of self esteem than do those entering psychiatry as a second career. These differences and their ramifications for the resident and the residency are discussed.

Differences appear in the formation of a professional identity as a psychiatrist when that career is the second career as opposed to the formation of that identity when the career is the first. For most older psychiatric residents, a first career typically precedes the entrance into psychiatry. In my case, I was …

On Becoming A Psychiatrist: A Resident's Perspective, Phebe M. Tucker, M.D.

Jefferson Journal of Psychiatry

Developing an identity as a psychiatrist is a process which has been seen by many to span an individual's career; from the first decision of choice of a career, through residency training and beyond, into the years of practice. As part of a "Residents' Day Paper," psychiatrists in the Oklahoma City area were surveyed in order to look at their perceptions of the growth of their professional identities. Despite the limitations of a small sample population, limited to one metropolitan area, some interesting common patterns emerged: the psychiatrists surveyed had diverse educational and cultural back grounds, similar practical and unconscious …

A Pilot Study Of Brief Group Therapies For Preschool Children: Parent Training Vs Group Play Therapy Vs Project Group, William S. Evans, Jr., M.D., Susan A. Black, M.D.

Jefferson Journal of Psychiatry

The optimum modality for treating preschool age children with behavioral and emotional problems is uncertain. One study showed that children with good ego strength respond to psychotherapy independent of whether it is group or individual psychotherapy, provided that a minimum period of psychotherapy occurs (ovick, 1965). The literature has demonstrated that parent training, individual play therapy, and group therapy are all effective modes of treatment with children (Axline, 1969; Moreland, et ai, 1983; Pesco solido & Petrella, 1986). Due to the limited psychiatric resources in the military setting and increasing demand for service, the option for individual therapy may be …

The In-Hospital Suicide: A Psychological Autopsy Of A System Involving Borderline Dynamics, Kathleen A. Hughes, Md, Al Santos, Md

Jefferson Journal of Psychiatry

This manuscript reviews principles of hospital management in the care of severe borderline patients with concomitant affective syndromes. The case presented highlights a process of experiential learning in a novice clinician (a beginning psychiatric resident) and illustrates several critical areas of concern with these patients. The following four facets of clinical management are discussed: 1) Failed attempts to understand borderline dynamics and subsequent countertransference reactions; 2) Staff resistance to consistent, honest and open acknowledgement of suicide potential; 3) Special risks when borderline dynamics are combined with affective syndromes; and 4) Possible suicide preventive measures and their relative effectiveness.

Conversion Hallucinations In A Patient With Pseudohypoparathyroidism, John Kasckow, Md, Ph.D., Allan Maltbie, Md

Jefferson Journal of Psychiatry

There are few case reports in the literature which discuss psychiatric disturbances in patients with pseudohypoparathyroidism (PH P) (1,2). PHP is a disease characterized by an inadequate response to parathyroid hormone . Often these patients are obese with a short, stocky build and moon-shaped face. Mental retardation is present in as many as 10% of these patients; a reversible dementialike syndrome can also occur (2,3). In addition, Capgras' syndrome has been observed in pseudohypoparathyroid patients (1,2). In these last two reports the authors concluded that the psychosis was probably organically-based. Hay et al (I) noted in their case report that …